肾病综合征患者合并甲状腺功能异常的影响因素分析

Risk Factors of Nephrotic Syndrome Complicated with Thyroid Dysfunction

目的:分析肾病综合征(NS)合并甲状腺功能异常患者的临床特征,探讨NS患者合并甲状腺功能异常的独立影响因素,为临床诊治提供理论依据。方法:选取2015年1月—2021年12月就诊于宜昌市中心人民医院的499例NS患者,分为甲状腺功能正常组(n=187)和甲状腺功能异常组(n=312),进一步细分为亚临床甲减组(n=112)、临床甲减组(n=86)及正常甲状腺病态综合征(ESS)组(n=114)。分析比较各组患者的一般人口学资料及实验室检查指标,TH、TSH水平与临床指标之间的相关性,并采用单因素及多因素Logistic回归分析NS患者合并甲状腺功能异常的影响因素。结果:NS患者合并甲状腺功能异常的发生率为62.53%(312/499);甲状腺功能正常组和异常组患者相比,性别、住院天数、24小时尿蛋白定量(24 h-UTP)、尿素氮(BUN)、血清白蛋白(Alb)、总胆固醇(CHOL)、C反应蛋白(CRP)、血沉(ESR)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和TSH方面差异有统计学意义(均P<0.05)。亚临床甲减组及临床甲减组的ESR、CHOL水平,ESS组BUN水平均高于甲功正常组(均P<0.05)。亚临床甲减组、临床甲减组及ESS组的Alb水平均低于甲功正常组(均P<0.05);进一步的Spearman相关分析显示,NS合并甲状腺功能异常患者的FT3、FT4及TSH水平与24 h-UTP、Alb、BUN、Scr等水平相关(均P<0.05)。多因素Logistic回归分析结果表明,血清Alb水平升高(OR=0.866,95%CI:0.813,0.923)是NS患者合并甲状腺功能异常的独立保护因素,女性患者(OR=2.629,95%CI:1.603,4.312)及高水平BUN(OR=1.099,95%CI:1.023,1.181)是发生甲状腺功能异常的独立危险因素(均P<0.05)。结论:女性患者、高水平BUN是NS合并甲状腺功能异常的独立危险因素,血清Alb水平升高是其保护因素。

Objective:To analyze the clinical characteristics of nephrotic syndrome(NS)patients with thyroid dysfunction,and explore the independent influencing factors of thyroid dysfunction in NS patients,providing theoretical basis for clinical diagnosis and treatment.Methods:A total of 499 NS patients treated in Yichang Central People's Hospital from January 2015 to December 2021 were selected and divided into the normal thyroid function group(n=187)and the thyroid dysfunction group(n=312),patients were further subdivided into subclinical hypothyroidism group(n=112),clinical hypothyroidism group(n=86),and euthyroid sick syndrome(ESS)group(n=114).The demographic informations and laboratory indicators of different patient groups were compared.The relationship between TH or TSH levels and clinical markers were investigated.The factors influencing thyroid dysfunction in patients with NS were explored using univariate and multivariate Logistic regression analysis.Results:The incidence of thyroid dysfunction in NS patients was 62.53%(312/499).Significant differences were found in gender,length of hospital stay,24-hour urine protein quantitation(24 h-UTP),urea nitrogen(BUN),serum albumin(Alb),total cholesterol(CHOL),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),free triiodothyronine(FT3),free thyroxine(FT4),and TSH between the normal thyroid function group and the thyroid dysfunction group(all P<0.05).Levels of ESR and CHOL in the subclinical hypothyroidism group and clinical hypothyroidism group,as well as BUN levels in the ESS Group,were significantly higher compared to the normal thyroid function group(all P<0.05).Conversely,the level of Alb in the subclinical hypothyroidism group,clinical hypothyroidism group,and ESS Group were significantly lower than those in the normal thyroid function group(all P<0.05).Further Spearman correlation analysis showed that the levels of FT3,FT4,and TSH in NS patients with thyroid dysfunction were correlated with 24 h-UTP,Alb,BUN,Scr,etc(all P<0.05).The results of multivariate Logistic regression analysis showed that increased serum Alb level(OR=0.866,95%CI:0.813,0.923)was an independent protective factor for thyroid dysfunction in NS patients,while female patients(OR=2.629,95%CI:1.603,4.312)and high levels of BUN(OR=1.099,95%CI:1.023,1.181)were independent risk factors for thyroid dysfunction(all P<0.05).Conclusion:Female patients and high levels of BUN are considered as independent risk factors for thyroid dysfunction in NS patients,while increased serum Alb level is a protective factor.